Use of a protease inhibitor, ulinastatin, for reexpansion pulmonary edema following evacuation of bilateral pleural effusion

OBJECTIVE To present a case of a patient with clinical and radiological features of reexpansion pulmonary edema, a rare and potentially fatal disease. CASE DESCRIPTION An 11-year-old boy presenting fever, clinical signs and radiological features of large pleural effusion initially treated as a parapneumonic process. Due to clinical deterioration he underwent tube thoracostomy, with evacuation of 3,000 mL of fluid; he shortly presented acute respiratory insufficiency and needed mechanical ventilation. He had an atypical evolution (extubated twice with no satisfactory response). Computerized tomography findings matched those of reexpansion edema. He recovered satisfactorily after intensive care, and pleural tuberculosis was diagnosed afterwards. COMMENTS Despite its rareness in the pediatric population (only five case reports gathered), the knowledge of this pathology and its prevention is very important, due to high mortality rates. It is recommended, among other measures, slow evacuation of the pleural effusion, not removing more than 1,500 mL of fluid at once.

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Edema de reexpansión pulmonar “REPE” intraoperatorio tras toracoscopia mediante ventilación unipulmonar

Revista Electrónica AnestesiaR ◽

10.30445/rear.v10i12.776 ◽

2019 ◽

Vol 10 (12) ◽

pp. 1

Author(s):

Marta Vicente Orgaz ◽

María Uriarte Valiente ◽

José María Ahijado Agudo ◽

Ernesto Martínez García ◽

María Pilar Orgaz Gallego

Keyword(s):

Pleural Effusion ◽

Pulmonary Edema ◽

Mediastinal Mass ◽

Capillary Permeability ◽

Rare Event ◽

Lung Ventilation ◽

One Lung Ventilation ◽

Left Pleural Effusion ◽

Factores De Riesgo ◽

Reexpansion Pulmonary Edema

El “REPE” (Re-expansion Pulmonary Edema) es una complicación poco común que puede ocurrir después del drenaje rápido de un neumotórax o de abundante líquido pleural (1,2). La incidencia en adultos es del el 0-1%. Su mortalidad puede alcanzar el 20% (1,3). Las hipótesis propuestas para el desarrollo de dicha entidad incluyen, el aumento de la permeabilidad de la microvasculatura pulmonar, cambios en el flujo linfático, disminución de la producción de surfactante y aumento de la presión hidrostática del flujo vascular del pulmón reexpandido (4). Se caracteriza por el desarrollo agudo de hipoxemia refractaria al oxígeno y la aparición de infiltrados alveolares intersticiales en un plazo de 24 horas tras el drenaje (5). Son factores de riesgo de REPE: la edad comprendida entre los 20 y 40 años, la duración del colapso pulmonar mayor de 72 horas, la aplicación de altas presiones negativas durante la toracocentesis (20 cm H2O), una rápida reexpansión tras drenajes de altos volúmenes de líquido pleural (> 1.5 L) o la existencia de factores predisponentes para el edema pulmonar (hipoalbuminemia, estasis en la circulación pulmonar). ABSTRACT Intraoperative reexpansion pulmonary edema “REPE” following thoracoscopy by one lung ventilation The sudden pulmonar expansion which has remained collapsed among different hours or days, likewise the fast pneumothorax or pleural effusion drainage, can cause a flash or acute edema on the affected lung. It is believed that the rexpansive pulmonary syndrome (REPE), is caused due to an increment in the capillary permeability after being exposed the affected lung to high negative intra-pleural pressure. The ocurrence of REPE is a rare event with most cohort studies reporting an incidence of between 0%- 1%. It may extend with hypoxaemia, hypotension and even cardiac arrest. The treatment of these patients include mechanical ventilation with optimal PEEP levels, the use of vasopressors and an intesive electrolyte resuscitation. We expose the case of a 16 year old patient with mediastinal mass diagnosis and massive left-pleural effusion, where after a thorascocopy for biopsy and pleuritic drainage, it is observed a reexpansion pulmonary edema with respiratory repercussion, haemodynamics and the requirement of endotracheal reintubation.

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Contralateral reexpansion pulmonary edema with ipsilateral collapsed lung after pleural effusion drainage: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-015-0272-3 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 4

Author(s):

Jae Jun Kim ◽

Yong Hwan Kim ◽

Si Young Choi ◽

Seong Cheol Jeong ◽

Seok Whan Moon

Keyword(s):

Case Report ◽

Pleural Effusion ◽

Pulmonary Edema ◽

Reexpansion Pulmonary Edema

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Acute unilateral reexpansion pulmonary edema after pleuropulmonary decortication

10.33118/oaj.rep.2019.01.010 ◽

2019 ◽

Author(s):

Belliraj Layla

Keyword(s):

Pleural Effusion ◽

Early Diagnosis ◽

Thoracic Surgery ◽

Respiratory Distress ◽

Pulmonary Edema ◽

Rare Complication ◽

Postoperative Course ◽

Unilateral Pulmonary Edema ◽

Reexpansion Pulmonary Edema ◽

Tuberculous Pleurisy

The development of unilateral pulmonary edema at the time of reexpansion is a rare complication often associated with aspirational drainage of a pneumothorax. It has been described exceptionally in the postoperative course of a pleural surgery. The main involved factors are prolonged atelectasis, reexpansion pulmonary effusion, the importance and duration of pleural effusion. This complication must be known to anesthesiologist during thoracic surgery for its mortality, which is evaluated at 20% in the litterature and that an early diagnosis allows the an effective treatment. We report an acute respiratory distress in the immediate postoperative course of pleuropulmonary decortication for a recurrent tuberculous pleurisy. Keywords: Unilateral Pulmonary Edema, Pneumothorax, Pleural Effusion.

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Re-expansion pulmonary edema after large left pleural effusion

Journal of Lung Pulmonary & Respiratory Research ◽

10.15406/jlprr.2021.08.00245 ◽

2021 ◽

Vol 8 (1) ◽

pp. 21-22

Author(s):

Bilal Chaudhry, MD ◽

Kirill Alekseyev, MD, MBA ◽

Lidiya Didenko MS ◽

Nikita Donti, DO

Keyword(s):

Pleural Effusion ◽

Pulmonary Edema ◽

Rare Complication ◽

Fatal Case ◽

Tension Pneumothorax ◽

Rapid Expansion ◽

Intermediate Care ◽

High Flow Oxygen ◽

Left Pleural Effusion ◽

Reexpansion Pulmonary Edema

Background: Reexpansion pulmonary edema (REPE) is a complication that arises from a precipitous or rapid expansion of a collapsed lung. This rare complication is thought to arise after using an intercostal drainage tube in patients with a tension pneumothorax, those with large pleural effusions, and occasionally when used therapeutically in thoracentesis. There are a multitude of risk factors, and it usually self-limiting, with the mainstay of treatment being supportive with oxygen. It is believed that 20% of cases are fatal. Case report: A 60-year-old male was treated with a 28 French tube for a large left pleural effusion. He developed REPE shortly after and developed severe shortness of breath, for which he required high flow oxygen. He was managed in the Intermediate Care Unit (IMCU) and shortly after was discharged home.

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